Long-Term Follow-up of patients on Drug Holiday from Bisphosphonates: Real-World Setting

Chiha, Maguy; Myers, Lauren; Ball, Caroline; Sinacore, James; Camacho, Pauline M.

doi:10.4158/ep12425.or

Cited by 17 publications

(13 citation statements)

References 12 publications

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“…BTMs, in combination with BMD, are used successfully to monitor so‐called drug holidays from BPs . These “drug holidays” aim to avoid administering BPs continuously for more than a few years.…”

Section: Pharmacodynamicsmentioning

confidence: 99%

Pharmacology of bisphosphonates

Cremers

Drake

Ebetino

et al. 2019

Brit J Clinical Pharma

164

107

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The biological effects of the bisphosphonates (BPs) as inhibitors of calcification and bone resorption were first described in the late 1960s. In the 50 years that have elapsed since then, the BPs have become the leading drugs for the treatment of skeletal disorders characterized by increased bone resorption, including Paget's disease of bone, bone metastases, multiple myeloma, osteoporosis and several childhood inherited disorders. The discovery and development of the BPs as a major class of drugs for the treatment of bone diseases is a paradigm for the successful journey from "bench to bedside and back again". Several of the leading BPs achieved "blockbuster" status as branded drugs. However, these BPs have now come to the end of their patent life, making them highly affordable. The opportunity for new clinical applications for BPs also exists in other areas of medicine such as ageing, cardiovascular disease and radiation protection. Their use as inexpensive generic medicines is therefore likely to continue for many years to come. Fifty years of research into the pharmacology of bisphosphonates have led to a fairly good understanding about how these drugs work and how they can be used safely in patients with metabolic bone diseases. However, while we seemingly know much about these drugs, a number of key aspects related to BP distribution and action remain incompletely understood. This review summarizes the existing knowledge of the (pre)clinical and translational pharmacology of BPs, and highlights areas in which understanding is lacking.

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Section: Pharmacodynamicsmentioning

confidence: 99%

Pharmacology of bisphosphonates

Cremers

Drake

Ebetino

et al. 2019

Brit J Clinical Pharma

164

107

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“…Failure of BP treatment occurs when there is ≥4% loss at the hip or spine in BMD or when there is any BMD loss at both the hip and the spine simultaneously [15]. Chiha et al evaluated patients on drug holidays and observed no significant difference in mean lumbar spine BMD over 4 years of drug holiday but reported a statistically significant decline in the femoral neck BMD after 2 years [16].…”

Section: Resultsmentioning

confidence: 99%

Bisphosphonate Treatment in Osteoporosis: Optimal Duration of Therapy and the Incorporation of a Drug Holiday

2015

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“…(18,25) Caution should be taken in elderly patients with low BMD as they may fracture during the DH despite years on treatment. (26) The efficacy of the use of bisphosphonate therapy in osteoporosis resulting in an increase in BMD and a reduced risk of fractures is well proven. (27) The greatest and only statistically significant increase in BMD on treatment, of 12.9%, was observed at LS (P < 0.001) compared to all the other sites.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Bisphosphonate Drug Holiday on the Bone Mineral Density in Patients with Osteoporosis

Rutendo¹,

Farzahna²,

Frederick³

2021

Wits Journal of Clinical Medicine

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Background: Bisphosphonate therapy has proven efficacy in the management of osteoporosis. Unlike other therapies, bisphosphonates are unique in that they continue inhibiting bone resorption after a discontinuation of therapy. Rare adverse effects related to its prolonged use, specifically osteonecrosis of the jaw and atypical femur fractures, resulted in the concept of a "drug holiday" (DH).Objective: To evaluate the effect of a bisphosphonate DH on bone mineral density (BMD) in the treatment of osteoporosis with zoledronic acid and/or alendronate.Methods: A single-centre retrospective cohort study of 97 patients with osteoporosis who had received bisphosphonate therapy and undertaken a DH between 2000 and 2016 was conducted at a large public academic hospital in Johannesburg, South Africa.Results: A total of 97 patients were included in the study. The median age at the initiation of bisphosphonate therapy was 63 years. The median duration of treatment before the DH was 5 years with the median duration of the DH being 2 years. The overall effect of the DH on BMD assessed as the percentage change from the beginning to the end of the DH showed a decrease in BMD lumbar spine [−3.3%, P = 0.398], radius and ulnar [−16.7%, P = 0.03] and total hip [−8.9%, P = 0.001]. Four patients (4.1%) sustained fractures during the DH. Conclusion:A DH should be cautiously considered with the long-term use of bisphosphonates. An individualised approach based on risk factor assessment, fracture risk, and BMD is key in assessing the duration of the DH, and only low-risk patients should be considered.

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Long-Term Follow-up of patients on Drug Holiday from Bisphosphonates: Real-World Setting

Cited by 17 publications

References 12 publications

Pharmacology of bisphosphonates

Pharmacology of bisphosphonates

Bisphosphonate Treatment in Osteoporosis: Optimal Duration of Therapy and the Incorporation of a Drug Holiday

Impact of a Bisphosphonate Drug Holiday on the Bone Mineral Density in Patients with Osteoporosis

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